A case of lung injury resembling diffuse pulmonary hemorrhage after the first administration of alemtuzumab in a patient with multiple sclerosis. Role of the HRCT

Diffuse pulmonary hemorrhage (DPH) is an uncommon, acute condition characterized by a variable combination of hemoptysis, dyspnoea, anemia, hypoxernia, and an initial nonspecific imaging features such as diffuse and bilateral ground glass pulmonary opacities that can be induced by different causes. DPH is a rare manifestation of adverse drug reactions. We report here the case of a 25-year-old woman that has been admitted to our pulmonary clinic for the onset of chest pain, cough and haemoptysis, started one week after her first treatment with alemtuzumab for multiple sclerosis. Computed tomography (CT) scan of the chest at the admission showed diffuse and bilateral ground glass pulmonary opacities. Her symptoms resolved completely without any treatment, after the interruption of alemtuzumab, and a CT scan of the chest performed one month later showed total disappearance of the pulmonary opacities

An unusual cause of chest pain

Case report :We present the case of a 27year-old male who went to the Emergency Room for the acute onset of chest pain irradiated to left flank and fever by 2 days. An abdominal computed tomography (CT) scan, performed for the suspicion of a kidney stone, showed a left basal pulmonary opacity. The patient was admitted to our department for suspected community-acquired pneumonia (CAP) but, a few days later, a chest CT scan with intravenous contrast revealed a thoracic congenital malformation: intralobar pulmonary sequestration. The pulmonary lesion was resected and the histopathological examination of the lesion showed the features of pulmonary sequestration. Conclusions :Pulmonary sequestration is a rare congenital malformation that is usually diagnosed in the Pediatric age. We report here an unusual case of intralobar pulmonary sequestration in an adult mimicking a CAP and a lung cancer

Neurotoxic and Neuroprotective Role of Exosomes in Parkinson's Disease

Exosomes are extracellular vesicles produced by eukaryotic cells that are also found in most biological fluids and tissues. While they were initially thought to act as compartments for removal of cellular debris, they are now recognized as important tools for cell-to-cell communication and for transfer of pathogens between cells. They have attracted particular interest in neurodegenerative diseases for their potential role in transferring prion like proteins between neurons, and in Parkinson's disease (PD), they have been shown to spread oligomers of α-synuclein in brain accelerating the progression of this pathology. A potential neuroprotective role of exosomes has also been equally proposed in PD as they could limit the toxicity of α-synuclein by clearing them out of the cells. Exosomes have also attracted considerable attention for use as drug vehicles; being non-immunogenic in nature, they provide an unprecedented opportunity to enhance delivery of incorporated drugs to target cells. In this review, we discuss current knowledge about the potential neurotoxic and neuroprotective role of exosomes, and their potential application as drug delivery systems in PD

A case of fibrosing interstitial pneumonia

We report here the case of a 70 year-old male, lifelong never smoker, who has been admitted to our inpatient Pulmonology clinic for the presence by one month of persistent fever associated in the last seven days with fatigue and mild exertional dyspnea (2 at the Borg scale). An arterial blood gas analysis performed during oxygen therapy [fractional concentration of oxygen in inspired gas (FiO2) of 40%] showed the presence of an acute hypoxemic respiratory failure. He had a past medical history of paroxysmal atrial fibrillation treated in the last two years with low-dose amiodarone and edoxaban. High-resolution computed tomography of the chest showed a bilateral, but with the prevalence in the right lung, pattern of interstitial lung disease with diffuse ground glass opacities with high attenuation, interstitial thickening, traction bronchiectasis and honeycombing. A diagnosis of amiodarone-induced pulmonary fibrosis was done and the drug was stopped and replaced with bisoprolol and concomitant treatment with systemic glucocorticoids for two weeks was started. The patient was discharged at home without respiratory failure. The patient died five months later in the Pulmonology clinic “Vittorio Emanuele” University Hospital of Catania, Italy during another acute exacerbation of its disease. Our report is a reminder for clinicians to recognize that even low-dose amiodarone (200 mg/daily) may be associated with severe pulmonary fibrosis. There is a complete absence of a standardized approach to the diagnosis and treatment of this disease

AN UNUSUAL CASE OF CHRONIC AIRFLOW OBSTRUCTION IN A HEAVY SMOKER

We report here the case of a 49-year-old perimenopausal woman, current smoker of 30 pack-years, that was referred to our attention in our outpatient pulmonology clinic for the presence of progressive exertional dyspnea and persistent cough. In the last five years the patient has been seen in many different pulmonology outpatient clinics for the presence of chronic airflow obstruction and performed four computed tomography of the chest that showed the presence of a diffuse and bilateral cystic pattern in the lung parenchyma. After a careful differential diagnostic approach including medical history, lung function tests, laboratory exams and chest imaging reanalysis a diagnosis of pulmonary Langerhans Cell Histiocytosis was made with therapeutic recommendation of cigarette smoking cessation. Chronic airflow obstruction and diffuse and bilateral cystic lung disease have many different causes. A complex differential diagnosis must be applied to every patient to understand the etiology and to provide the specific treatment

Diffusion-Weighted Imaging in Oncology: An Update

To date, diffusion weighted imaging (DWI) is included in routine magnetic resonance imaging (MRI) protocols for several cancers. The real additive role of DWI lies in the "functional" information obtained by probing the free diffusivity of water molecules into intra and inter-cellular spaces that in tumors mainly depend on cellularity. Although DWI has not gained much space in some oncologic scenarios, this non-invasive tool is routinely used in clinical practice and still remains a hot research topic: it has been tested in almost all cancers to differentiate malignant from benign lesions, to distinguish different malignant histotypes or tumor grades, to predict and/or assess treatment responses, and to identify residual or recurrent tumors in follow-up examinations. In this review, we provide an up-to-date overview on the application of DWI in oncology

Impact of coronavirus disease 2019 (COVID-19) emergency on Italian radiologists: a national survey

To perform an online survey aimed at evaluating the impact of COVID-19 on Italian radiology departments

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)